impact, effectiveness, & future application of positive behaviour teams in the provision of...
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Impact, Effectiveness, & Future Application of Positive Behaviour Teams
in the provision of disability support services
in Western Australia
A Research Report Commissioned by the Disability Services Commission, WA
Assoc. Prof. Keith McVilly (Deakin University, Vic)[email protected]
Today’s Presentation
• Brief background and context to the PBT
• Provide an overview of the research process
• Describe some of the key findings • Outline some of the key
recommendations and action to date
The Positive Behaviour Team• An interdisciplinary tertiary level team
within the Disability Services Commission
• Commenced in 2007, in response to the “Sector Health Check”
• Now operating as part the Positive Behaviour Framework (formalised in 2009)
Team Mission
‘To encourage lasting, positive behaviour change and improved quality of life of the person with a disability and their family by increasing the capacity of the person, their environment and support systems’
Client Group• People with a developmental disability
• Aged 6-25
• Who exhibit challenging behaviour
• Living in a family context
Staffing• Clinical Psychology
• Speech Pathology
• Social Work
• (Occupational Therapy)
The 3-pillars
– Family Systems Approaches + CCA
– Applied Behaviour Analysis + PBS
– Functional Communication
Two-fold Focus• Positive Behaviour Change
• Promoting Family Quality of Life
A Collaborative Model• Working WITH families
• To DISCOVER the what, why, and how to act; and build a SHARED understanding
• Utilising a TRANSDISCIPLINARY model of team work
Research Objectives• To determine the impact & effectiveness of the services provided by
the PBT.
• To establish an evaluation framework & management tool for on-going support of the PBT
• To provide a framework to inform evidence-based practices in future sector-wide developments involving PBT services.
Research Activities July 2008 to December 2010
Formative & Summative approach
•Documentation review•Development of Research Protocol with PBT•Database Development •Family Interviews & Surveys•Staff Interviews & Surveys•LAC Focus Group•Community Teams Focus Group•School & Respite Service Interviews
Family Measures
•Beach Center on Disability (2003). Partnership and family quality of life survey. University of Kansas.
•Cummins, R., & Lau, A. (2006). Personal Wellbeing Index, 4th Edition. Melbourne: Deakin University.
•Einfeld, S. & Tong, B (2002). Developmental Behaviour Checklist, Revised. Melbourne, Australia: Centre for Developmental Psychiatry & Psychology, Monash University.
•Hammer, A., & marting, M. (1987). Coping Resources Inventory. Palo Alto, CA: Consulting Psychologists Press.
•Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales. (2nd. Ed.). Sydney: Psychology Foundation
•Stepping Stones Positive Parenting Program (2003) Parenting Scale. Queensland, Australia: Author.
Family Interviews
The Partnership Orientation Measure
Garbacz, S., Woods, K., Swanger-Gagne, M., Taylor, A., Black, K., & Sheridan, S. (2008). The Effectiveness of a Partnership-Centred Approach in Conjoint Behavioral Consultation. School Psychology Quarterly, 23 (3), 313–326.
Quality of Family – Professional PartnershipsSummers, J., Hoffman, L., Marquis, J., Turnbull, A., Poston, D., Nelson, Louis (2005). Measuring the quality of family – professional partnerships in special education. Exceptional Children, 72 (1), 65-81.
Measure of Processes of Care (MPOC-20)
King, S., King. G, & Rosenbaum, P. (2004). Evaluating Health Service Delivery to Children With Chronic Conditions and Their Families: Development of a Refined Measure of Processes of Care (MPOC–20). Children’s Health Care, 33(1), 35–57.
Measure of Beliefs About Participation in Family-Centered Services
King, G., Kertoy, M., King, S., Law, M., Rosenbaum, P., & Hurley, P. (2003). A Measure of Parents’ and Service Providers’ Beliefs About Participation in Family-Centered Services. Children’s Health Care, 33(3), 191-214.
Staff Measures
King, G., Kertoy, M., King, S., Law, M., Rosenbaum, P., & Hurley, P. (2003). A Measure of Parents’ and Service Providers’ Beliefs About Participation in Family-Centered Services. Children’s Health Care,
Maslach, C. & Jackson, S. (1986). Human Services Survey. Palo Alto, CA: Consulting Psychologists Press 33(3), 191-214.
Osipow, S. & Spokane, A., (1998). Occupational Stress Inventory Revised Edition (OSI-R): Professional Manual. USA- Psychological Assessment Resources, Inc.
Clients of the PBT• Referrals = 114
• Accepted Cases = 102
• Active at December 2010 = 32
– Assessment = 9
– Intervention = 19
– Maintenance = 4
• Engagement =
M 383 days (SD 203)
13 to 763 days
• ID = 39%
• ASD = 18%
• ID + ASD = 43%
• Males = 81%
• Mean Age = 14 (SD3.11)
• Range = 5 to 27 years
• Mode = 11 yrs (12.5%)
Issues for the Person with Disability
• Aggression = 31%
• Aggression & Self-Injury = 25%
• Non-compliance = 20%
• Risk-taking = 11%
• Residual > socially unacceptable behaviour; toileting issues;
Issues for the Family
Personal Wellbeing
• PWI Fathers =
M 6.4 / 10 (SD 1.5)
• PWI Mothers =
M 5.75 / 10 (SD 1.3)
• Child’s safety• School exclusion• Safety of family members• Impact on parent’s relationship• Impact on siblings• Communication • Social Skills • Control • Independence
Gains over time• Goal Attainment for PWD
– Met = 32%
– Partially Met = 45%
– Discontinued = 13%
– Unmet = 10% (3 clients)
• Family QoL
Significant Improvement:
M 3.2 (SD 0.58) >
M 3.7 (SD 0.45)
• Parental Efficacy
Significant Improvement:
M 54.25 (SD 11.6) >
M 61.88 (SD 7.9)
• Parental Mental Health
Significant Improvement:
M 33.77 (SD 23.03) >
M 24.81 (SD 19.08)
Developmental Behaviour Checklist (DBC)
• Initial assessment - maladaptive behaviour profile at levels significantly above those to be expected of both typically developing children and children with disability.
• Behaviours included: externalised disruptive and antisocial behaviour, internalised self-absorbed behaviours, disturbed communication, heightened levels of anxiety, and poor social relatedness.
• Behaviours assessed to be as maladaptive or worse than that to be expected of at least 80% of children (with or without disability),
• Total Problem Behaviour Scores at approximately the 90th percentile.
Developmental Behaviour Checklist (DBC)
• Following intervention, statistically significant improvements on the Total Problem Behaviour Score.
Pre: 79.24 (SD21.39) < Post 56.88 (21.96)
Aus Norm 41 / Clinical @ 46
• Total scores were decreasing towards the 70th percentile.
• Notably, statistically significant improvements were evident in the ratings of disruptive and antisocial behaviour, and in respect to social relatedness.
• Though remaining above the level accepted as indicative of psychopathology
Improved Circumstances• Some measures did
not show statistically significant change from pre to post.
• However, family circumstances became statistically indistinguishable from available norms
• Personal Wellbeing Index
• Depression Anxiety & Stress Scale
• Coping Resources Inventory
What conclusions can we make?
• Family breakdown and premature out of home moves have been prevented
• Parents report they are more knowledgeable about their son or daughter, & their support needs
• Parents report they are more able to cope effectively with the challenges of parenting
Underlying Messages• The PBT is being very successful in very difficult
circumstances
• However, it is evident that many families remain fragile
• Many parents report poor mental health (depression & anxiety)
• Longer-term family centred supports remain a priority
Why Might it be Effective?
•The report has generated 62 recommendations
•Positive Behaviour Support Techniques
•Communications Strategies
•Multi-Systemic Family Therapy & Education
•Experienced
•Multi-disciplinary Team
• working in a
•Trans-disciplinary framework
•Regulated Referrals
•Extended Engagement
•Family & networks
Summary of actions on recommendations
• Referral processes simplified, but more comprehensive screening; working with LACs
• Enhanced goal setting
• Maintenance & review process
• Working with CALD and Aboriginal families
• Family mental health• Siblings
Summary of actions on recommendations
• Review of assessments
• Induction process for team and in-service professional development
• Interagency collaboration
• Enhanced IT – video + iPads